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Many Pa. residents caught in health insurance gap

Andre Butler, 48, of Chestnut Hill, is just one of 400,000 Pennsylvania residents who, according to the Pennsylvania Health Access Network, will fall into the coverage gap between traditional Medicaid and the Affordable Care Act marketplace on Jan. 1.

Butler, who works as an on-call banquet server or bartender, had hoped to buy health insurance through the Affordable Care Act marketplace. Unfortunately, he makes too little to qualify for the exchange but makes too much to qualify for Medicaid.

In June 2012, the Supreme Court upheld all provisions in the Patient Protection and Affordable Care Act. In the ruling, the court determined that the most controversial provision – an individual mandate requiring people to have health insurance – was valid as a tax. While the court also found the ACA’s Medicaid expansion constitutional, it struck down the penalty (loss of all Medicaid funding) for states that opt not to expand the program. As a result of that decision, states can opt not to expand Medicaid without the risk of any penalty to their existing Medicaid programs.

Gov. Tom Corbett initially rejected the Medicaid expansion, saying the state could not continue to grow an entitlement program. Corbett recently released his alternative plan to expanding Medicaid called “Healthy Pennsylvania.”

In a press release, Corbett said his plan to improve and modernize the Medicaid program “provides a state-based solution to ensure increased access to health care for all Pennsylvanians in a fiscally sustainable manner.”

Leesa Allen, executive director of Pennsylvania’s Medicaid program, said the Governor’s plan includes two critical parts: reforming the Medicaid program and offering a private coverage option for uninsured Pennsylvanians.

“The current Medicaid program was not designed to encourage personal responsibility including encouraging positive behaviors,” Allen said. “We want to have a program that will engage individuals in having a hand in improving their health, whether it’s seeing their family doctor instead of using the ER or helping them move out of poverty by seeking employment opportunities. Reforming Medicaid is a critical first step to being able to sustain the program and cover more individuals.”

Under Corbett’s proposal, Butler would qualify for Medicaid, but would be required to pay a $25 monthly premium and meet certain work-requirements or risk losing coverage.

Butler, who suffers from chronic pain in his legs and hips, said the governor’s plan is just a political maneuver to get reelected.

Butler added that the governor has a pattern of cutting aid to the working class under the guise of “reform.” He said the governor continues to target programs that effect “people who are already living on the fringe.”

Butler said Corbett got rid of adult basic insurance, reduced funding for food stamps, cut funding for public schools and wants to reduce the number of people eligible for traditional Medicaid.

“This is a governor that when he ran said unemployed people don’t want to work,” Butler said.

Butler said the governor’s decision not to expand Medicaid will hurt tax payers in the long run.

“The Medicaid expansion is a win-win for the state because it would provide economic stimulus to Pennsylvania by supporting job growth,” Butler said. “There is no reason why we should have to wait when other people will be able to get health insurance on Jan. 1.

Butler said voters need to keep the pressure on our legislators to expand Medicaid.

“I believe at some point logic will win and he will do the right thing for the commonwealth,” Butler said.

Bob Previdi, 51, of Chestnut Hill, agrees with Butler and said the state should opt to expand Medicaid.

“We are paying taxes, why not get the benefit,” Previdi said. “What is ironic here is that the Republicans are fighting against the Affordable Care Act – a plan that was crafted based on an example in Massachusetts, which was drawn up by the Heritage Foundation – a conservative think tank and installed under Gov. Romney.”

Antoinette Kraus, director of the Pennsylvania Health Access Network, doubts the federal government will approve the waiver because currently under Medicaid law people who are 100 percent below the federal poverty level can’t be charged premiums.

“The Corbett administration decided at the 11th hour to craft a complex plan in comparison to other states like Ohio and New Jersey that decided to go the traditional route and expand Medicaid to working adults,” Kraus said. “This plan is nothing more than an unnecessary delay that places additional burdens on hard-working Pennsylvanians.

“Expanding coverage right away will not only protect 613,000 low-income Pennsylvanians who will finally have access to stable, affordable health coverage, it will also generate $522 million in state budget savings in 2014 and keep us on track to create 35,000 new, good-paying jobs across the Commonwealth,” Kraus said. “Delaying by a year will mean much needed revenue to our state lost and another year Pennsylvanians will be forced to gamble with their health.”

Kraus said the work requirement will create a lot of red tape and could make it more difficult for people to have access to affordable health insurance.

“In Pennsylvania, 80 percent of folks who are eligible for the new coverage have at least one full-time worker in their household,” Kraus said. “So, it’s really a waste of resources and money on a problem that doesn’t exist.”

According to the Kaiser Foundation in a study conducted in 2008, 57 percent of uninsured adults with a family income below 133 percent of poverty were working.

Even if Gov. Corbett’s plan is approved it will not be available for at least a year.

While Allen said the timeline is really dependent upon negotiations between the federal government and the Pennsylvania Department of Public Welfare (DPW). As part of the formal process required by the federal government to obtain the waiver, DPW will hold six public hearings across the state and two webinars.

“We are really looking forward to the opportunity to begin the public process,” Kraus said.

A public meeting on the proposed “Healthy Pennsylvania” plan will be held on Jan. 3 from 10 a.m. to 1 p.m. at the National Constitution Center, 525 Arch St., in Center City Philadelphia. Residents interested in speaking at the hearing must call 1-877-395-8939 to register before Dec. 30. Written comments can also be submitted to the DPW via email at RA-PWHEALTHYPA1115@pa.gov.